FORM II-A
Form of application for certification for public exhibition of a film imported into India
[See sub-rule (1) of rule 21]

No. and date of application (to be entered by Board’s office)

To
The Central Board of Film Certification through the Regional Officer at .................
Application for certification for public exhibition of a video film first imported into India at ..................................................

1. 1. Name of the video film
   2. Language of the video film
   3. Running time of video film. _________________ minutes. Running time of the video film as shown in the CCP and /or import licence. Have any cuts been made voluntarily by the applicant and if so give details
   4. Number of cassettes
   5. Any other particulars of the video conversion
   6. Type of the film i.e., whether it is 2-D, 3-D, cinemascope, vistavision etc.
   7. Whether the film is silent or a talkie
   8. Colour of the film
   9. Name & address of the producer
   10. Name of the director
   11. Country in which produced
2. State whether the video film is a *newsreel/documentary/scientific/educational/feature/advertisement video film.
3. State separately, the number of negative and positive prints of the video film.
   
   1. imported by the applicant (negative ____________ positive ____________)
   2. in the applicant’s possession (negative __________ positive ____________)
4. 1. Whether the video film for which the application has been made is a replica/exact copy of a Cinematograph film on celluloid in respect of which a certificate has already been granted by the Central Board of Film Certification ? Also state particulars of the film certified.
   2. Whether the video film is a modified version of a certified Cinematograph film on celluloid containing additions, deletions/ other alterations (details of modification may be provided).
   3. Whether the application being made is in respect of an original video film and not a copy of an already certified Cinematograph film on celluloid.
   4. In what other language/languages, if any, has this been produced or dubbed?
      Where the title is not the same in each language, state the title of each version in which it has been produced or dubbed.
5. Has any previous application been made to certify this video film (under its present or any other title) in
   
   1. India :
   2. United State of America :
   3. United Kingdom :
   4. Any other country :

   If so,

   1. Where and to whom was it made?
   2. What was the result of the application i.e.
   1. * A ‘U’/’UA’/ An ‘A’/’S’ certificate No. __________ date _______was granted subject to the following cuts :
   2. *Certificate was refused.
      In the case of film made in the United States of America, state the rating of this film according to (a) the national groups and (b) the legion of decency.
      (a) ____________________________ (b) ______________________________
6. Has exhibition of this video film been at any time suspended or the film declared unrestricted by the Central or and State Government? State particulars :
7. Does the video film contain any dialogue, song, poem, speech or commentary in any language other than English or any Indian language?
   If so, specify the cassette or cassettes in which the dialogue, song, poem, speech or commentary occurs and the language or languages used.
8. Amount of fee accompanying the application account of the fee prescribed in rule 36.
   
   1. Receipt No.____________ dated _____________________________
   2. Bank draft No. __________ dated _________ on __________ Bank
   3. Postal order No. __________ dated ________ on ______Post Office.
9. Name, address and telephone number, if any, of the applicant.
   ___________________________________________________________________
   
   ___________________________________________________________________
   
10. 1. Name, address and telephone number, if any of the importer of the video film ___
    2. Number and date of the import licence ________________________________
    3. Date of clearance through the customs _________________________________
11. Has the video film/film been produced by or in collaboration with South African or Rhodesian national wholly or part in South Africa, South West Africa or Rhodesia or is the film owned wholly, or in part, by South African or Rhodesian nationals? If so, give details. />[11. (A) Whether any animal has been used in shooting of the film? If so, whether declaration specified in clause (bb) of sub-rule (3) of rule 21 has been filled?]1
12. I declare that the video film is ready for examination by the Board and the statements recorded above are true in every particular. I also declare that I own the rights of the video film in question. I further declare that I have the right to use in the video film additional material in the feature film in the form of trailers, dvertisement shorts, documentary films etc.

Date :

Signature of applicant